The purpose of this Notice is to inform potential applicants that the National Cancer Institute (NCI) is participating in PA-18-499, "End-of-Life and Palliative Care Health Literacy: Improving Outcomes in Serious, Advanced Illness (R21 Clinical Trial Optional)."

The following changes have been made to reflect NCI's participation in this FOA:

Part 1. Overview Information

Components of Participating Organizations
National Institute of Nursing Research (NINR)
National Cancer Institute (NCI)

Catalog of Federal Domestic Assistance (CFDA) Number(s)

93.361, 93.399

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

The text that follows this sentence is hereby to be considered as information inserted at the end of the original Funding Opportunity Description in Part 2, Section I, of PA-18-499 .

In addition to research areas already listed in the Funding Opportunity Description, NCI is interested in applications that address important gaps in this area, including applications that:

Address barriers to access and utilization of end-of-life and palliative care services for patients diagnosed with advanced cancer, particularly among those with limited health literacy. Some of the identified barriers include, but are not limited to: lack of knowledge about end-of-life and palliative care (EOLPC) services, financial concerns, poor communication between care providers and patients/caregivers, and stigma associated with the end of life.

Develop and test health literacy tools for advanced cancer patients and caregivers, training programs for providers, and multi-level or multi-component interventions or care delivery models that promote discussions of prognosis and goals of care, including decision-making about advanced care planning actions (e.g., Do-Not-Resuscitate [DNR] orders, transition to supportive care and hospice) between patients, caregivers, and the healthcare provider team.

Develop, test, and evaluate patient-centered cancer care delivery models and interventions that enable the provision of palliation simultaneously with active treatment, including in the context of cancer clinical trial participation.

Develop and test approaches to effectively ascertain patient values, preferences, goals, and priorities, as well as models to deliver value-concordant care for patients diagnosed with advanced cancer.

Conduct mixed methods research on the communication of prognosis, goals of care, and uncertainty in cancer. Such research projects should extend beyond patient-provider dyads to include cancer care teams and informal cancer caregivers.

Develop feasible, precise, and interpretable approaches to collecting patient-generated health data, including approaches that utilize patient-reported outcomes (PROs) and data from symptom monitoring devices, from patients with advanced cancers (particularly those patients who are identified as having limited health literacy).